Multinational Comparisonsof Health Systems Data, 2009
Gerard F. Anderson and Patricia MarkovichJohns Hopkins University
November 2009
Support for this research was provided by The Commonwealth Fund. The views presented here are those of the authors and not necessarily those of The Commonwealth Fund or its directors, officers, or staff.
THECOMMONWEALTH
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2International Comparison of Spending on Health, 1980–2007
0
1000
2000
3000
4000
5000
6000
7000
8000
19
80
19
81
19
82
19
83
19
84
19
85
19
86
19
87
19
88
19
89
19
90
19
91
19
92
19
93
19
94
19
95
19
96
19
97
19
98
19
99
20
00
20
01
20
02
20
03
20
04
20
05
20
06
20
07
U.S.NorwaySwitzerlandCanadaNetherlandsFranceGermanySwedenU.K.ItalyNew ZealandAustralia
Average spending on healthper capita ($US PPP)
0
2
4
6
8
10
12
14
16
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
U.S.FranceSwitzerlandGermanyCanadaNetherlandsNew ZealandSwedenNorwayItalyU.K.Australia
Total expenditures on healthas percent of GDP
Source: OECD Health Data 2009 (June 2009).
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3Average Annual Growth Rate of
Real Health Care Spending per Capita, 1997–2007
1.7
2.32.42.42.5
3.73.83.8
4.04.14.2
4.5
4.9
0.0
1.0
2.0
3.0
4.0
5.0
UK NZ NETH SWE OECDMedian
CAN AUS* US FR ITA NOR SWITZ GER
* 1996–2006Source: OECD Health Data 2009 (June 2009).
Percent
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4Out-of-Pocket Health Care Spending per Capita, 2007
Adjusted for Differences in Cost of Living
213246
343351
470485528542571580
720
890
1,350
0
200
400
600
800
1,000
1,200
1,400
SWITZ US NOR CAN AUS* ITA SWE OECDMedian
GER NZ UK FR NETH
* 2006Source: OECD Health Data 2009 (June 2009).
Dollars
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5Health Care Expenditure per Capita by Source of Funding, 2007
Adjusted for Differences in Cost of Living
3,3074,005
2,618 2,726 2,844 2,7582,124
2,4462,056
3,092
449589 510
360
441
890
720
1,350 580 246 470528
571
542
2,716
38
88
20479 343
0
1,000
2,000
3,000
4,000
5,000
6,000
7,000
8,000
US NOR SWITZ CAN FR GER SWE AUS* UK ITA
Out-of-pocket spending
Private spending
Public spending
* 2006Source: OECD Health Data 2009 (June 2009).
Dollars
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6Hospital Spending per Discharge, 2007
Adjusted for Differences in Cost of Living
17,206
12,163 11,988
9,398 9,131 9,026
7,312 7,312 7,295
4,667 4,527
0
2,000
4,000
6,000
8,000
10,000
12,000
14,000
16,000
18,000
US* CAN* NETH SWITZ NOR* SWE NZ OECDMedian
AUS* FR GER
* 2006Source: OECD Health Data 2009 (June 2009).
Dollars
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7Hospital Discharges per 1,000 Population, 2007
84
109
126126135139
162163165166172
227
274
0
50
100
150
200
250
300
FR GER NOR SWITZ SWE OECDMedian
AUS* ITA* NZ US* UK NETH CAN*
* 2006Source: OECD Health Data 2009 (June 2009).
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8Average Length of Hospital Stay for Acute Myocardial Infarction, 2007
4.64.85.4
6.26.46.8
7.17.1
7.98.0
8.9
11.0
0
2
4
6
8
10
12
GER UK ITA* SWITZ NETH OECDMedian
CAN* FR AUS* US* SWE NOR
* 2006Source: OECD Health Data 2009 (June 2009).
Days
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Community Hospital Payment-to-Cost Ratios, by Source of Revenue, 1980-2008
Note: Payment-to-cost ratios show the degree to which payments from each payer cover the costs of treating its patients. They cannot be used to compare payment levels across payers, however, because the service mix and intensity vary. Data are for community hospitals. Medicaid includes Medicaid Disproportionate Share payments.
Source: American Hospital Association and Avalere Health, Avalere Health analysis of 2008 American Hospital Association Annual Survey data, for community hospitals, Trendwatch Chartbook 2010, Trends Affecting Hospitals and Health Systems, Table 4.4, p. A-35, at http://www.aha.org/aha/trendwatch/chartbook/2010/appendix4.pdf.
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10Average Annual Number of Physician Visits per Capita, 2007
7.57.0
6.3 6.3 6.3
5.8 5.7
5.04.7
4.03.8
2.8
0
1
2
3
4
5
6
7
8
GER ITA** AUS FR OECDMedian
CAN* NETH UK NZ SWITZ US* SWE*
* 2006 ** 2005Source: OECD Health Data 2009 (June 2009).
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11Number of Practicing Physicians per 1,000 Population, 2007
2.2
3.9 3.9 3.93.7
3.63.5
3.43.2
2.8
2.52.4
2.3
0
1
2
3
4
NETH NOR SWITZ ITA SWE* GER FR OECDMedian
AUS* UK US NZ CAN
* 2006Source: OECD Health Data 2009 (June 2009).
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12Pharmaceutical Spending per Capita, 2007
Adjusted for Differences in Cost of Living
$241
$381$422$431$446$446$454
$518$542
$588
$691
$878
0
100
200
300
400
500
600
700
800
900
US CAN FR GER ITA SWITZ SWE OECDMedian
AUS* NETH NOR NZ
* 2006Source: OECD Health Data 2009 (June 2009).
Dollars
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13Drug Prices for 30 Most Commonly Prescribed Drugs, 2006–07
US is set at 1.0
0.34
0.440.450.490.51
0.63
0.760.77
1.00
0.0
0.2
0.4
0.6
0.8
1.0
US CAN GER SWITZ UK AUS NETH FR NZ
Source: IMS Health.
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14Drug Prices for 30 Most Commonly Prescribed Drugs, 2006–07,
Brand-Name and GenericUS is set at 1.0
Source: IMS Health.
AUS CAN FR GER NETH NZ SWITZ UK US
Brand-Name Drugs
0.40 0.64 0.32 0.43 0.39 0.33 0.51 0.46 1.00
Generic Drugs 2.57 1.78 2.85 3.99 1.96 0.90 3.11 1.75 1.00
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15Drug Prices: Lipitor (atorvastatin), 2006–07
Price for one dose
$0.71
$1.01
$1.35$1.45$1.45$1.46$1.52
$1.83
$2.82
$0
$1
$2
$3
US CAN SWITZ AUS UK NETH GER FR NZ
Source: IMS Health.
Dollars
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16Drug Prices: Nexium (esomeprazole), 2006–07
Price for one dose
$0.88$1.02
$1.22$1.28$1.32
$1.97$2.15
$3.91
$0
$1
$2
$3
$4
US SWITZ CAN UK NETH FR AUS GER
Source: IMS Health.
Dollars
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Profitability of Pharmaceutical Manufacturers, 1995-2009
Note: Percent is the median percent net profit after taxes as a percent of firm revenues for all firms in the industry. NA = no longer available. Source: Kaiser Family Foundation and Sonderegger Research Center, Prescription Drug Trends: A Chartbook Update, November 2001, Exhibit 4.11, at http://www.kff.org/insurance/3161-index.cfm, updated with data from Fortune, Fortune 500 Industry Rankings: April 14, 2003, Vol.147, No.7, p. F-26; April 5, 2004, Vol. 149, No.7, p. F-26; April 18, 2005, Vol. 151, No.8, p. F-28; April 17, 2006, Vol.153, No.7, p. F-26; April 30, 2007, Vol.155, No.8, p. F-32; 2007 and 2008 numbers from Fortune 500 online at http://money.cnn.com/magazines/fortune/; 2009 numbers from personal communication with Fortune magazine.
NA
NA
NA
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18Magnetic Resonance Imaging (MRI) Machines
per Million Population, 2007
25.9
18.6
14.4
8.8 8.5 8.2 8.26.7 6.6
5.75.1
0
10
20
30
US ITA SWITZ NZ OECDMedian
GER UK CAN NETH** FR AUS
** 2005Source: OECD Health Data 2009 (June 2009).
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19MRI Scan and Imaging Fees, 2009
1,200
839 824
567
436
179
0
200
400
600
800
1,000
1,200
1,400
US GER CAN NETH FR UK
Source: International Federation of Health Plans, 2009 Comparative Price Report.
Dollars
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21Volume of Knee and Hip Implants, 2004
Implants per 100,000
164
137
121
95
65
0
50
100
150
200
US UK GER FR ITA
Source: McKinsey & Company, Accounting for the Cost of Health Care in the United States, 2007.
258
208197
141 139
0
50
100
150
200
250
300
GER FR UK ITA US
Knee Replacements Hip Replacements
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22Cost of Knee and Hip Prostheses to Providers, 2004
GDP Adjusted, US $
4,866
3,035
2,5612,390
2,239
0
1,000
2,000
3,000
4,000
5,000
6,000
US ITA FR UK GER
Source: McKinsey & Company, Accounting for the Cost of Health Care in the United States, 2007.
$4,821
$1,537$1,380
$1,168 $1,165
US ITA UK GER FR
Knee Replacements Hip ReplacementsDollars
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23Coronary Bypass Procedures per 100,000 Population, 2007
3132
132
8581
77 7673 73
59 58 56
45
0
25
50
75
100
125
150
GER US* NOR* NZ AUS* ITA* CAN* OECDMedian
NETH SWE UK FR SWITZ
* 2006Source: OECD Health Data 2009 (June 2009).
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24Percentage of Population over Age 65
with Influenza Immunization, 2007
77.5 77.073.5
69.066.7
64.9 64.3 63.7
58.956.0 56.0
0
10
20
30
40
50
60
70
80
AUS* NETH UK FR US ITA CAN NZ OECDMedian
GER SWITZ
* 2006
a
Source: OECD Health Data 2009 (June 2009).
Percent
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25Percentage of Adults Who Report Being Daily Smokers, 2007
1515
29
25
2322 22 22
21 20
18 1817
0
5
10
15
20
25
30
NETH FR* GER** ITA OECDMedian
NOR UK SWITZ CAN NZ AUS US SWE*
* 2006** 2005Source: OECD Health Data 2009 (June 2009).
Percent
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26
34.3
26.5
24.0
15.413.6
11.2 10.5 10.2 9.99.0
8.1
0
5
10
15
20
25
30
35
US* NZ UK CAN GER** NETH FR* SWE ITA NOR SWITZ
Obesity (BMI>30) Prevalence Among Adult Population, 2007
* 2006** 2005Note: BMI = body mass index. For most countries, BMI estimates are based on national health interview surveys (self-reported data). However, the estimates for the US, UK, and New Zealand are based on actual measurements of weight and height, and estimates based on actual measurements are usually significantly higher than those based on self-report.
Source: OECD Health Data 2009 (June 2009).
Percent
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27Life Expectancy at Birth, 2007
81.1 80.782.282.382.382.482.983.083.083.784.084.284.4
78.2 77.1 75.477.278.077.278.278.978.479.078.479.277.5
0
10
20
30
40
50
60
70
80
90
FR SWITZ* ITA* AUS CAN* SWE NOR* GER* NETH OECDMedian
NZ UK** US*
Female Male
* 2006** 2005Source: OECD Health Data 2009 (June 2009).
Years
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28Potential Years of Life Lost Because of Diabetes
per 100,000 Population, 2007
19
2529313335363637
64
99
0
20
40
60
80
100
US** NZ** NOR* SWE* OECDMedian
GER* NETH ITA* FR* UK SWITZ*
* 2006** 2005Source: OECD Health Data 2009 (June 2009).
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29Mortality Amenable to Health Care
Deaths per 100,000 population*
* Countries’ age-standardized death rates before age 75; includes ischemic heart disease, diabetes, stroke, and bacterial infections.Data: E. Nolte and C. M. McKee, “Measuring the Health of Nations: Updating an Earlier Analysis,” Health Affairs, Jan./Feb. 2008 27(1):58–71.Source: Commonwealth Fund National Scorecard on U.S. Health System Performance, 2008.
7681
88 8489 89
99 9788
97
109 106116 115 113
130134
128
115
65 71 71 74 77 80 82 82 84 84 90 93 96104103103101
110
74
0
50
100
150
Fra
nce
Japan
Austr
alia
Spain
Italy
Canada
Norw
ay
Neth
erlands
Sw
eden
Gre
ece
Austr
ia
Germ
any
Fin
land
New
Zeala
nd
Denm
ark
United K
ingdom
Irela
nd
Port
ugal
United S
tate
s
1997–98 2002–03
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Distribution of National Health Expenditures, by Type of Service, 2008
Note: Other Personal Health Care includes, for example, dental and other professional health services, durable medical equipment, etc. Other Health Spending includes, for example, administration and net cost of private health insurance, public health activity, research, and structures and equipment, etc.
Source: Kaiser Family Foundation calculations using NHE data from Centers for Medicare and Medicaid Services, Office of the Actuary, National Health Statistics Group, at http://www.cms.hhs.gov/NationalHealthExpendData/ (see Historical; National Health Expenditures by type of service and source of funds, CY 1960-2008; file nhe2008.zip).
Physician/ Clinical Services 21.2%
Hospital Care 30.7%
Other Personal Health Care
12.9%
Nursing Home Care, 5.9%
Prescription Drugs10.0%
Home Health Care, 2.8%
Other Health Spending 16.5%
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Relative Contributions of Different Types of Health Services to Total Growth in National
Health Expenditures, 1998-2008
Nursing Home Care4.3%
Home Health Care2.7%
Other Personal Health Care
11.7%
Hospital Care29.8%
Prescription Drugs12.7%
Physician and Clinical Services
20.9%
Other Health Spending18.0%
Notes: Percentages may not total 100% due to rounding. Other Personal Health Care includes, for example, dental and other professional health services, durable medical equipment, etc. Other Health Spending includes, for example, administration and net cost of private health insurance, public health activity, research, and structures and equipment, etc.
Source: Kaiser Family Foundation calculations using NHE data from Centers for Medicare and Medicaid Services, Office of the Actuary, National Health Statistics Group, at http://www.cms.hhs.gov/NationalHealthExpendData/ (see Historical; National Health Expenditures by type of service and source of funds, CY 1960-2008; file nhe2008.zip).
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Annual Percentage Change in National Spending for Selected Health Services, 1998-
2008
Source: Kaiser Family Foundation calculations using NHE data from Centers for Medicare and Medicaid Services, Office of the Actuary, National Health Statistics Group, at http://www.cms.hhs.gov/NationalHealthExpendData/ (see Historical; National Health Expenditures by type of service and source of funds, CY 1960-2008; file nhe2008.zip).
4.5
5.96.97.2
7.48.08.2
8.2
5.65.0
3.2
5.05.85.7
7.37.3
8.57.9
8.5
7.0
5.26.4
3.2
4.5
8.7
5.8
8.4
10.5
14.014.7
15.3
18.1
14.1
0%
2%
4%
6%
8%
10%
12%
14%
16%
18%
20%
1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008
Hospital Care
Physician and Clinical Services
Prescription Drugs
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Distribution of National Health Expenditures, by Type of Service, 1998 and 2008
Notes: Percentages may not total 100% due to rounding. Other Personal Health Care includes, for example, dental and other professional health services, durable medical equipment, etc. Other Health Spending includes, for example, administration and net cost of private health insurance, public health activity, research, and structures and equipment, etc.
Source: Kaiser Family Foundation calculations using NHE data from Centers for Medicare and Medicaid Services, Office of the Actuary, National Health Statistics Group, at http://www.cms.hhs.gov/NationalHealthExpendData/ (see Historical; National Health Expenditures by type of service and source of funds, CY 1960-2008; file nhe2008.zip).
21.5%
7.4% 7.5%
2.8%
15.1%
10.0%
31.6%
14.0%
16.5%
2.8%
12.9%
5.9%
21.2%
30.7%
0%
10%
20%
30%
40%1998 2008
Hospital Care
Physician/ Clinical Services
Prescription Drugs
Nursing Home Care
Home Health Care
Other Personal
Health Care
Other Health
Spending
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Relative Contributions of Utilization, Types of Prescription Drugs Used, and Price to Rising
Prescription Drug Expenditures, 1993-1997 vs. 1997-2002
Source: Kaiser Family Foundation and Sonderegger Research Center analysis using National Health Expenditures data for prescription drugs from the Centers for Medicare and Medicaid Services, Office of the Actuary, National Health Statistics Group, at http://www.cms.gov/statistics/nhe/historical/, Table 2; price data from IMS Health, Pharmaceutical Pricing UPDATE, various years; and utilization data from IMS Health, National Prescription Audit Plus, various years, updated with data from the IMS Health web site at http://www.imshealth.com.
1993-1997 1997-2002
Price (Manufacturer
Price Increases)19% Utilization
(# of Prescriptions Dispensed)
47%Types of
Prescription Drugs Used
34%
Price (Manufacturer
Price Increases)25%
Utilization (# of
Prescriptions Dispensed)
42%
Types of Prescription Drugs Used
34%